Braces

A Patient's Guide to Back and Neck Braces

Introduction

If you are diagnosed with a spinal disorder, deformity, or potential problem
that can by helped through the use of external structural support, your physician
may recommend the use of a back or neck brace. Braces offer a safe, non-invasive
way to prevent future problems or to help you heal from a current condition.

The use of braces is widely accepted. They are effective tools in the treatment
of spine disorders. In fact, more than 99% of orthopedic physicians advocate
using them.

Braces are really nothing new. They have actually been around for centuries.
Lumbosacral corsets (for the lower back) were used as far back as 2000 B.C.!
Bandage and splint braces were used in 500 A.D. in an effort to correct scoliosis
(a spine with a sideways curve). Recently, braces have become a popular way
to actually help prevent primary and secondary lower back pain from ever occurring.

There are more than 30 types of back supports available for spine disorders.
This website will discuss several common types and why they are used.

This website will cover:

Neck Braces

Trochanteric Belts

Sacroiliac and Lumbosacral Belts

Corsets

Rigid Braces

Hyperextension Braces

Molded Jackets

Lifting Belts

Clinical Uses

Goals of Spinal Bracing

Possible Drawbacks

Neck Braces

Neck braces are used to provide stability of the cervical spine after neck
surgery, a trauma to the neck, or as an alternative to surgery. They are probably
the type of spinal brace you most commonly see people wearing. There are several
types available, including:

Soft Collar - This flexible brace is placed around the neck. It is typically
used after a more rigid collar has been worn for the major healing. It is used
as a transition to wearing no collar.

Philadelphia Collar - This is a more rigid/stiff collar that has a front
and back piece that attaches with Velcro on the sides. It is usually worn 24
hours a day until your physician instructs you to remove it. This collar is
used for conditions such as: a relatively stable cervical (upper spine) fracture,
cervical fusion surgery, or a cervical strain. Another similar type is the Miami
cervical brace.

Sterno-Occipital Mandibular Immobilization Device (SOMI) - A SOMI
is a brace that holds your neck in a straight line that matches up with your
spine. It offers rigid support to a damaged neck and prevents the head from
moving around. With this brace, you are unable to bend or twist your neck. The
restriction of motion helps the muscles and bones to heal from injury or surgery.

If you look at what the name means, you will better understand what a SOMI
does: "sterno" means your upper and middle chest, "occipital" is the base of
your skull, "mandibular" refers to your jaw and chin, and "immobilization" describes
the support and movement restriction the brace offers. The SOMI is worn on the
parts of the body for which it is named. First, there is a chin piece that the
lower jaw rests on. Second, the chin piece connects by straps to a headband
that is worn across the forehead. Third, the chin piece connects to a chest
piece by a front metal extension. Finally, the chest piece then rests on the
upper and middle chest - sort of like a vest. This connects to the occipital
piece, which supports the base of the head.

This brace is obviously a bit more complicated and cumbersome than some of
the others, but it provides excellent support for an injured neck.

Halo - The main purpose of the halo is to immobilize the head and neck.
This is the most rigid of the cervical braces. It is only used after complex
cervical spine surgery or if there is an unstable cervical fracture. The halo
looks a lot like the word sounds. It has a titanium ring (halo) that goes around
your head, secured to the skull by four metal pins. The ring then attaches by
four bars to a vest that is worn on the chest. The vest offers the weight to
hold the ring and neck steadily in place. The Halo is worn 24 hours a day until
the spine injury heals.

Trochanteric Belts

The trochanteric belt is usually prescribed for sacroiliac joint pain or pelvic
fractures. The belt fits around the pelvis, between the trochanter (a bony portion
below the neck of your thigh bone) and the iliac (pelvis) ridges/crests. It
is about five to eight centimeters wide and it buckles in front, just like a
regular belt.

Sacroiliac and Lumbosacral Belts

The lumbosacral belt helps to stabilize the lower back. These belts are usually
made of heavy cotton reinforced by lightweight stays. The pressure can be adjusted
through laces on the side or back of the belt. These belts range in widths between
10 to 15 centimeters, and 20 to 30 centimeters. The sacroiliac belt is used
to prevent motion by putting a compressive force on the joints between the hipbone
and sacrum (base of the spine).

Corsets

Corsets provide rigidity and support for the back. Corsets can vary in length.
A shorter or longer corset will be prescribed, depending upon your condition.
A short corset is typically used for low back pain, while a longer one is used
for problems in the mid to lower thoracic spine. When people think of corsets,
they usually conjure up images of women from earlier centuries who used them
to make their waists look smaller. Today, in the treatment of back problems,
corsets refer to a type of back brace that extends over the buttocks and is
often held up by shoulder straps. Like the corsets of old, these lace up from
the back, side, or front. There are metal stays that provide the appropriate
rigidity and support for the back.

Rigid Braces

These braces are typically prescribed for low back pain and instability. If
greater rigidity is needed to support the spine than can be found in standard
back supports, rigid frame spinal bracing is often prescribed. These are stiff
braces. They usually consist of rear uprights that contour to the lumbar (lower)
spine and pelvis, along with thoracic bands. There are also fabric straps on
the braces that provide pressure in the front. Common types of rigid models
are:

Williams Brace - This type of brace has no vertical uprights in the
middle so that flexion/bending is allowed.

Chair-back Brace - This type immobilizes the lumbar spine in the neutral
position. The chair-back is designed to reduce sideways and revolving movement
of the lower spine.

This brace is designed to prevent excessive bending, and it is often prescribed
to treat frontal compression fractures that have occurred around the junction
of the thoracic and lumbar spine. The brace can also be used for post surgery
healing from a spinal fusion.

These braces offer support that allows anterior (front) pressure unloading
of the thoracic vertebrae by restricting flexion (bending) of the thoracic and
lumbar spine.

Hyperextension
braces have a front rectangular metal frame that puts pressure over the
upper sternum and the pubis/pubic bone. This encourages spinal extension. There
is opposing pressure applied over the T-10 level (the tenth vertebra in your
thoracic spine). The braces offer what is called "three-point stabilization"
to the spine through a front abdominal pad, a chest pad, and a rear pad at the
level of the fracture.

By applying pressure in three-points - sternal, pubis and rear Lumbosacral
- the spine is extended/stretched. The sternum is the narrow, flat bone in the
front middle of thorax. The thorax is the portion of body between the base of
the neck and the lower diaphragm.

The most common types of Hyperextension Braces are Knight Taylor and
Jewett.

Molded Jackets

These
jackets are designed to distribute pressure widely over a large area. By
immobilizing the patient from the neck to the hips, pressure is distributed
evenly, taking excess pressure off overloaded or unstable areas. These jackets
were originally made of plaster of Paris, but now are typically made out of
molded plastic.

Lifting Belts

These belts are designed to reduce low back strain and muscle fatigue that
can occur when you are lifting heavy objects. The belt circles around the waist,
covering the lumbar region of the spine, and closes in front. These belts are
usually made of cloth or canvas and do not have stays. Some models also have
lordosis pads.

Clinical Uses

The braces/supports are most frequently used to treat: low back pain, trauma,
infections, muscular weakness, neck conditions, and osteoporosis. Braces, belts,
and jackets are designed to immobilize and support the spine when there is a
condition that needs to be treated. Depending on the model that is used, they
can put the spine in a: neutral, upright, hyper-extended, flexed, or lateral-flexed
position.

Goals of Spinal Bracing

Spinal bracing is used for a variety of reasons such as to: control pain, lessen
the chance of further injury, allow healing to take place, compensate for muscle
weakness, or prevent or correct a deformity. More specifically, lumbar corsets
and braces compress the abdomen, which increases the intra-abdominal pressure.
This act allows pressure on the vertebral column to unload, providing some relief.

There are other reasons bracing is used. One is the theory that they insulate
the skin, producing increased warmth that decreases the sensation of pain -
much like a heating pad. Another reason is that the increase in abdominal pressure
produces hydraulic support for the back. Finally, certain types of movement
may cause stress to the pain generators in the back. The decrease in range of
movement by using bracing may relieve this type of pain.

Possible Drawbacks

Though the effects of bracing are primarily positive, they can lead to a loss
of muscle function, due to inactivity. Bracing can sometimes lead to psychological
addiction, so that even when the patient is healed and ready to be taken off
the back brace, he or she feels dependent upon it for physical support.